Healthcare catering – care home nutrition

Nutrition is an essential element of care provision for the elderly, especially those with dementia, and caterers have been developing strategies to help them serve the special needs of such customers. Siobhan O'Neill reports

With school meals dominating the headlines, the industry often focuses its attention on its youngest customers. But a rapidly growing customer base exists at the other end of the age spectrum, and their nutrition needs are, if anything, even more important than those of our schoolchildren.

We all know our society is ageing. But perhaps more importantly, the illnesses associated with old age are also increasing, and with those come added responsibilities for those in care catering, because they demand specialist diets. In particular, dementia care requires quite specific understanding of the illness by those responsible for delivering nutrition.

There are now more than 820,000 people affected by dementia in the UK. This is set to rise to over one million by 2025. More than 60% of all care home residents in the UK aged over 65 have a form of dementia. In recognition of these worrying statistics, Karen Oliver, chair of the National Association of Care Catering, launched the organisation's Nutritional Standards for Adults in June to help caterers ensure their menus deliver the mealtime needs of those in their care.

Consultant chef Hugh McGivern offers training for those catering in a care setting and three years ago was asked to devise a 24-hours-a-day, seven-days-a-week feeding plan for Caterplus. "I came up with the Bento Box, which is a grazing box, available 24/7, which works in conjunction with nutritious high-energy soups," says McGivern.

McGivern uses his understanding of food science to develop recipes and menus that address particular nutrition needs in dementia sufferers. With depleted taste buds many dementia patients enjoy stronger flavours or sweet foods. His Bento Boxes have a striking black-and-red design to attract the eye and they are left where wandering residents will spot them and can help themselves to a tasty and nutritious treat.

Using pictorial menus is another innovation McGivern recommends so that residents will recognise their food when it's brought to them. "I'll go into a care home and create a teaching programme that shows chefs the process they can follow so they can incorporate their own ideas and adapt it," he says. "It will change the ideas they've held. Often they're not creative any more. People aren't thinking outside the box, and there's not enough looking at it. I say to caterers, ‘You go home at the end of the day; these people live here. Don't tell me you know better when and what they want to eat.'"

Allowing people with dementia illnesses to have dignity and choice is a key theme within care catering. Robin Comerford is healthcare development executive at Elior, which provides catering in more than 100 care settings around the UK, but his background is with BUPA care homes. He's been impressed by Elior's commitment to specialised catering in the care industry. It works with charity Age UK to give its chefs training in how to respond to residents' individual needs, and even in what it feels like to be old and have restricted vision, hearing and movement.

"The Elior Academy does all the craft training, and Age UK provides training called Through Other Eyes," says Comerford. "It helps them prepare the right food and also how to interact with the resident. It's one thing to prepare their favourite dish, but if you give it to them when they're not hungry or plonk it down and the setting isn't right or it's out of reach - all those fundamentals contribute to a good eating experience. It's about the interaction with the resident. Care homes are inspected by the Care Quality Commission. They'll be looking at how engaged the staff are, how kind they are. We can show that we contribute to person-centred care. It helps the care home meet some of its regulatory requirements."

Elior also provides specialist moulded texture-modified foods for residents with dysphagia, the medical term for swallowing difficulties. "It's about nutrition, but it's also about dignity," says Comerford

A high percentage of those with dementia also have dysphagia, says Helen Blunn, dietitian at Apetito. She adds: "If you have dysphagia, you are at an increased risk of malnutrition, and with dementia people forget to eat or they don't feel hunger. We've launched our range of texture-modified foods, which are softer foods with a higher moisture content for those who have chewing and swallowing difficulties."

The texture-modified foods are a long way from the puréed meals of old. "Our texture-modified foods are moulded to look like the food you're eating, and it holds its shape when it's cooked," says Blunn. "So when you're serving it to your resident it looks like it should do rather than separate bits of purée in a bowl, which isn't allowing them to be very dignified. To be able to give someone a meal that looks like chicken and broccoli and potatoes and is shaped that way, it's amazing.

"We also try to ensure that the texture-modified foods are represented on the main menu, so it's not the case that the whole home is having chicken casserole and you end up with blended salmon. We try to ensure that they're all the same."

Comerford adds that it's important to recognise the effect dementia has on lifestyle and routine. "Dementia residents lose track of time, they lose their senses of smell and taste, they lose their appetite," he explains. "Consequently, they lose weight. Routine goes out of the window. Many will sleep during the day and walk around at night. The wanderers burn up a lot of calories and also lose weight because they're missing meal times or they won't sit down and eat."

To address this, Elior designed the Foodbox - much like McGivern's Bento Box, it is a Tupperware box full of the resident's favourite bits. Supported by a patient food profile, care staff meet with the resident or a relative and build up a list of favourite foods - sausage rolls, scotch eggs, celery sticks - and the box will be made up of this on the basis of "two bites and it's gone".

"It's finger food, easy to eat, tasty, appetising," Comerford says. "The box is made up and kept in a fridge and comes with a monitoring form for recording what's eaten. It's particularly useful for those who like to snack at night. A grazing diet."

Blunn suspects that, as numbers of dementia sufferers increase, more caterers will have to familiarise themselves with the issues. "I don't know if we'll go down the route of needing more specific nutrition, providing energy-dense foods, smaller portions, or looking at how food is served, but understanding is going to have to be increased," she says. "It's difficult to predict which clients are going to be in the care home setting, so you have to react and change according to the people we see. It's making food for the individual, which is why it's so important to make the food a dignified experience."

Tackling weight loss

Alykhan Kachra, managing director of Country Court Care Group

"Elior took over our catering in April. Our ambition is to improve the quality of our service in all areas. Our residents are all keen to know what the lunch is going to be; it's a real highlight of their day. Our aim was to make it a better experience for them. I didn't feel our managers could oversee that with all their other responsibilities, so we looked for someone to outsource to.

"Elior's Foodbox provision has been fantastic. It's a brilliant solution that works. They've got high levels of experience and training. They put together the correct nutritional values.

"When people are losing weight we need to be able to quantify what they're taking in. Elior is able to manage that for us. Their texture-modified food is so much more dignified, not only for the resident but for the family and everyone seeing them eating food that looks like food.

"One of our homes had seen quite a large weight loss among its residents and was finding it hard to deal with. Elior managed to tackle that very quickly and put in some fortified foods which were high in calories."

Food preparation, presentation and delivery

Maxine Cartz, dietitian for Whiteoaks, Compass Group's specialist senior living division

"There has been some really useful research on how to help people with dementia eat well, and this has helped us in developing the right methods for food preparation, presentation and delivery.

"Providing small meals often works well, and we can provide a 24/7 grazing solution so that these residents get little meals throughout the day and always have access to biscuits, sandwiches and fruit. It is also important that they have access to tea, milky drinks and water to help ensure they stay hydrated.

"People with dementia may not sit down for long periods of time, so providing them with a buffet-style solution enables them to walk around while eating, helping to ensure they eat more throughout the day.

"We've also found that providing the opportunity for carers to eat alongside residents with dementia encourages them to sit down for longer, as it feels more like a family dining experience, and invariably they eat a bigger meal."

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